Lung Flashcards
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How did the WashU RT lung toxicity differ from the STRIPE trial?
42% of patients in the WashU study received concurrent CRT while 100% of patients in the STRIPE trial
What was the study population in the Peking study investigating cis/etop vs carbo/taxol?
Unresectable stage III NSCLC
What was 3-and 5-year primary control and distant metastasis rate in the RTOG 0236 trial?
3-yr primary control: 98%<div>5-yr primary control: 93%</div><div><br></br></div><div>3-yr DM 22%</div><div>5-yr DM 24%</div>
<div>In the NRG/RTOG0915 trial, what was grade 3 toxicity and 5-yr primary control in the 34Gy/1fx vs 48/4fx?</div>
34 vs 48 Gy:<div>2.6% vs 11% grade 3 toxicity</div><div>89% vs 93% primary control</div>
Which group demonstrated low regional failure with omission of ENI in SCLC? (i.e. RT only directed to FDG avid areas)
Maastricht University, The Netherlands
What did the CASPIAN trial in extensive stage SCLC study?
durvalumab + tremelimumab + plat/etop<div>vs</div><div>durvalumab + plat/etop</div><div>vs</div><div>plat/etop</div>
What was predictive of radiation pneumonitis in the STRIPE trial?
-carbo/paclitaxel<div>-V20 (total lung - GTV)</div><div>->2Gy/fx</div><div>-lower lobe</div><div>-Age >65</div><div><br></br></div><div>If both age >65 and treated with carbo/taxol, then >50% risk of symptomatic pneumonitis</div>
What did the ‘CHISEL’ study investigate and what was it’s study population?
The CHISEL study compared SBRT vs EBRT in patients with T1-2 N0 M0 inoperable or refusing surgery.
What was the pCR in patients of the MISSILE trial treated with SBRT?
pCR 60%
What did the Netherlands Cancer Institute study in metastatic NSCLC?
Phase II trial, compared<div>SBRT 24 Gy in 3 fx followed by pembrolizumab</div><div>to</div><div>pembroluzimab</div><div><br></br></div><div>Prespecified endpoint was 3-month overall response rate of 50% vs 20%</div>
What is the IMpower133 trial in extensive stage SCLC?
atezolizumab (anti PD-L1) + carbo/etop<div>vs</div><div>placebo + carbo/etop</div><div><br></br></div><div>PCI allowed but not chest RT</div>
Which study population did the LUNG-ART trial study and what was the trial set-up?
pN2 NSCLC, s/p complete resenction<div><br></br></div><div>Goal of the study was to investigate adjuvant RT in N2 disease</div><div>patients received</div><div>post-op 54 Gy in 27-30 fx</div><div>vs</div><div>No RT</div>
What was the focus of the SWOG 9416 / INT 0160 study?
Superior sulcus tumors!
What was the difference between the SABR-COMET trial, the SINDAS trial, the OliGomez MDACC trial and the IAEA trial?
SABR-COMET trial: RT in oligometastastic disease of ANY histology<div>SINDAS trial: RT in oligometastatic NSCLC EGFR+</div><div>OliGomez MDACC: <u>Local consolidative therapy</u> in oligometastatatic NSCLC after chemo</div><div>IAEA: RT in oligometastatic NSCLC</div>
Describe general study results of the CONVERT trial
Outcomes (OS and PFS) trended in favor of BID RT<div>The trial was designed to show superiority and did not –> BID fractionation remains standard</div><div><br></br></div><div>Median OS was 30 months for the BID group (slightly larger than in the Turrisi/INT0096 trial)</div>
Which patients did the CREST study investigate?
ES-SCLC who responded to chemo, ECOG 0-2
What were study methods of the CREST study in ES-SCLC who responded to chemo?
30 Gy thoracic RT + PCI<div>vs</div><div>PCI</div><div><br></br></div><div>Primary endpoint was 1-yr os</div>
What was the regimen studied in the INT 0139/RTOG 9309?
Neoadjuvant CRT + Surgery vs Definitive RT<div>In particular:</div><div>45 Gy with concurrent cis/etoposide</div><div>if no PD</div><div>–> Surgery vs RT to 61 Gy total</div><div>Then adjuvant x2 cis/etoposide in both arms</div>
What was median OS in CALGB 39801 for induction vs no induction chemo?
12 months vs 14 months
What did the CALGB 39904 trial investigate?
Hypofractionation (70 Gy in various doses) in stage I NSCLC (<= 4cm) and poor pulmonary function
What was 2-year DFS and 2-year CNS FFR in the ADAURA trial comparing adjuvant osimertinib for 3 years vs placebo in EGFR+ NSCLC? What was the conclusion based on these findings?
Overall 2-year DFS was 89% vs 52%<div>2-year CNS FFR was 98% vs 85%</div><div><br></br></div><div>Conclusion: osimertinib improves DFS and reduces CNS relapse in completely resected EGFR+ NSCLC</div>
What were SBRT doses in SABR-COMET?
SBRT to 30-60Gy/3-8 fx<div>or single fx of 16-24 Gy for brain, spine</div>
What was median PFS in the SABR-COMET trial?
12 vs 6 months
What is the Goustave-Roussy study?
A meta-analysis of 6 trials evaluating concurrent vs sequential chemoRT
What did CALGB 39801 investigate?
No induction chemo vs Induction chemo (2 cycles of carboplatin and paclitaxel) in patients with unresectable stage III NSCLC<div><br></br></div><div>Otherwise, all patients received 66 Gy Rt with concurrent weekly x7 weeks carboplatin and paclitaxel</div>
What was the conclusion of the CALGB 39801?
The addition of 2 cycles of induction carboplatin and paclitaxel increased toxicity and provided no OS benefit
Explain the radiation regimen for both arms in the CHISEL study.
SBRT 54 Gy / 3 fx (or 48 Gy / 4 fx if <2cm from chest wall)<div>vs</div><div>3D CRT to 66 Gy, or 50 GY in 20 fx</div>
What was the conclusion of the CHISEL study?
SBRT improved LC and OS compared to conventional RT.
Which SBRT dose did the NRG/RTOG 0915 investigate?
34 Gy / 1 fx<div>vs</div><div>45 Gy / 4 fx</div><div><br></br></div><div>Medically inoperable T1-T2N0M0 peripheral lesions</div>
What is the conclusion of the caspian trial?
Durvalumab + platinum/etoposide improves OS in extensive stage SCLC compared to chemo alone.<div>The addition of tremelimumab to durvalumab + chemo did not improve outcomes</div>
<div>What were the lung constraints in the TROVO trial?</div>
Contralateral lung V5 < 17%<div>Mean lung < 24 Gy</div><div><br></br></div>
In the SWOG trial, what was the 2-and 5-yr OS in all patients and in the patients with complete resection?
All patients: 2yr OS 55%, 5yr OS 44%<div>In patients with complete resection: 2yr OS 70%, 5yr OS 53%</div>
What was 2-yr LC, median OS and 2-yrs OS in the CHISEL study?
<div>For SBRT vs EBRT:</div>
2-yr LC was 89% vs 65%<div>Median OS was 5 yrs vs 3 yrs</div><div>2-yr OS was 77% vs 59%</div>
What was RT volume in the CREST trial investigating thoracic RT in ES-SCLC?
RT volume was post-chemo volume of involved nodal levels with 1.5 cm margin. Involved levels were included whether CR or not.
What did the SMART trial (Clive et al., Lancet Oncol) evaluate in mesothelioma patients?
Immediate vs deferred RT (for later mets) to tracts<div>RT to tract was 21 Gy / 3fx</div>
Which trials established improved OS with concurrent CRT vs sequential CRT?
RTOG 9410 and Goustave-Roussy
What was the regimen studied in the RTOG 0617?
Dose escalation, cetuximab being;<div>60 Gy vs 74 Gy</div><div>and</div><div>cetuximab (concurrent and consolidation) vs no cetuximab</div><div><br></br></div><div>All patients received carbo/taxol concurrent weekly and ajuvant x2!</div>
What did the STRIPE study investigate?
Meta-analysis of 12 studies investigating RT lung toxicity with chemo
What did the CALGB 8433 study?
RT alone vs induction + RT in locally advanced NSCLC<div>RT 60 Gy</div><div>induction: cis/vinblastine</div>
What were the results and the interpretation of the Lung Cancer Study group 821?
Improved LC with lobectomy over wedge<div>Trend to increase in overall death and cancer death with wedge resection</div>
What did the ANITA trial study?
The ANITA trial investigated adjuvant chemo vs observation in resected stage IB-IIIA patients.
What is another name for the LUNG-ART study?
EORTC 22055
What was the rate of DM in squamous vs nonsquamous NSCLC in the RTOG 0236 which investigated SBRT in peripheral lesions.
DM in squamous 6%, nonsquamous 32%
What was the conclusion of a Pfizer study evaluating crizotinib in advanced NSCLC with ROS1 rearrangement?
Crizotinib has impressive response rates in ROS1 rearranged tumors<div><br></br></div><div>ORR:72%</div>
What did the Turrisi trial/INT0096 establish?
45 Gy/30 fx BID as standard therapy for limited-stage SCLC
How was the hippocampal avoidance region created in the PREMER trial?
The hippocampus was contoured after which a 5-mm volumetric expansion was created around the hippocampus.
Which country first established success with consolidative thoracic RT in ES-SCLC?<div>Describe their methods.</div>
Yugoslavia<div>they investigated</div><div><br></br></div><div>cis/etop x3 then if distant CR and local CR/PR</div><div>–> thoracic RT 54 Gy/36 fx BID + cis/etop x2</div><div>vs</div><div>cis/etop x4 followed by PCI</div>
What was the incidence of grade >= 2 pneumonitis and grade >=3 esophagitis in the Peking study (cis/etop vs carbo/taxol)?<div>Break-down per group.</div>
Grade >= 2 pneumonitis 19% vs 33%<div>Grade >= 3 esophagitis 20% vs 6%</div><div>for</div><div>cis/etop vs carbo/taxol</div>
Describe study set-up of the SCLC Turrisi trial aka as INT 0096.
Patients with limited stage SCLC were included<div>45 Gy in 1.8 Gy daily</div><div>vs</div><div>45 Gy in 1.5 Gy BID fractions</div><div><br></br></div><div>WITH concurrent cisplatin and etoposide x4 cycles q3 weeks</div><div>RT started with cycle 1</div>
What was the main criticism of the THORA trial comparing 45Gy BID vs 60Gy in 40 for limited stage SCLC?
Not analyzed according to ITT!
What were the results in terms of 2-yr OS in the PORT MetaAnalysis trialists group?
2-yr OS of 58% vs 53% with PORT<div>–> PORT worsens OS in early stage, resected NSCLC</div>
In the EORTC 08941, how many of patient in the surgery arm received PORT?
40%
What did the CONVERT trial study?
Dose escalation in limited-stage SCLC<div><br></br></div><div>cis/etop x1, then</div><div>45 Gy in 1.5 Gy BID or 66 Gy in 33 fx</div><div><br></br></div><div>4-6 cycles cis/etop</div>
What was the conclusion of the Japanese PCI trial? (National Kyushu Cancer Center, Fukuoka,Japan)
No OS benefit with PCI, BM improved<div>1-yr OS 54% vs 48%</div><div>1-yr brain mets 33% vs 59%</div>
What is median OS in the CASPIAN trial for the 3 study arms?
10.4 months in durvalumab + tremelimumab + plat/etop<div>12.9 months in durvalumab + plat/etop</div><div>10.5 months in plat/etop</div>
Describe study set-up of the TROVO (IJROBP 2020, NCI of Aviano, Italy) trial in malignant pleural mesothelioma.
Phase III study<div>Lung-sparing surgery and platinum + pemetrexed followed by hemithoracic tomotherapy 50 Gy to pleural cavity + 60 Gy SIB to gross disease</div><div>vs</div><div>Lung-sparing surgery and platinum + pemetrexed followed by palliative radiation to surgical scar and/or gross residual<br></br></div>
What was mean OS in the TROVO malignant mesothelioma trial for each study arm?
58% vs 28%<div>in favor of the group with hemithoracic RT as compared to palliative radiation to scar and/or gross residual disease</div>
What was incidence of procedure tract metastasis in the SMART study?
9% vs 16%, p= 0.14<div>There is a trend to benefit of immediate RT to procedure tracts in mesothelioma, but the results were nonsignificant and do not support routine use.</div>
In the RTOG 0617, what was the 2-yr and 5-yr OS for 74 Gy vs 60 Gy in patients with unresectable stage III NSCLC
2 yr OS was 45% for 74 Gy vs 58% for 60 Gy<div>5 yr OS was 23% for 74 Gy vs 32% for 60 Gy</div>
When was chemo and radiation given in the LUNG-ART trial?
Chemo was given either neoadjuvant or adjuvant<div>Radiation was either given 2-6 weeks after chemo (chemo adjuvant)</div><div>or</div><div>4-8 weeks after surgery (chemo neo-adjuvant)</div>
What was the study set-up of the SWOG 9416 / INT 0160
2-cycles of cis/etop + 45 Gy –> if no progression then surgery in 3-5 weeks –> followed by cis/etop x2
What was the conclusion of the meta-analysis performed by the ‘PCI Collaborative Group Gustave-Roussy?
Meta-analysis comparing PCI vs no PCI<div><br></br><div>PCI improves OS for SCLC in CR (5% increase at 3-years)</div><div>PCI leads to less brain mets (33% vs 59%)</div></div>
What was the conclusion of the PREMER trial?
Hippocampal avoidance preserves memory in SCLC PCI.
What is the clinical relevance of RTOG 0617?
1) In unresectable stage III NSCLC, dose escalation to 74 Gy led to worse outcome.<div>2) In unresectable stage III NSCLC, cetuximab provides no benefit in OS.</div>
What are the 5-year OS outcomes in standard of care treatment for Stage IIIA NSCLC in the RTOG 0617, PACIFIC and RTOG 9410
RTOG 0617: 66% 2-y OS<div>PACIFIC: 53% 2-y OS</div><div>RTOG 9410: 42% 2-y OS</div>
In the combined analysis of STARS and ROSEL, what was 3-y OS and 3-yrs RFS in SABR vs surgery?
3-yrs OS 95% SABR vs 79% surgery (significant)<div>3-yr RFS 86% SABR vs 80% surgery (ns)</div><div>However! Even this combined analysis is underpowered!</div>
Which studies comparing SABR vs surgery are ongoing?
VALOR and STABL-MATES<div>VALOR: VA office of research and development</div><div>STABL-MATES: UTSW</div>
What was the SINDAS trial?
Evaluated RT in oligometastasis<div>Specifically, in NSCLC, EGFR+, <=5 oligometastasis, non-intracranial</div><div><br></br></div><div>Phase III study</div><div>SBRT to all sites + TKI</div><div>vs</div><div>TKI</div>
What did the SABR-COMET study investigate? Describe inclusion criteria
RT in oligometastatic disease<div><br></br></div><div>Inclusion criteria:</div><div><= 5 oligometastases</div><div>any histology, controlled primary tumor from definitive treatment</div><div><br></br></div>
What was median OS and 5-year OS in the Turrisi trial/INT 0096?
Median OS was 23 months for bid vs 19 months for daily fractionation.<div>5-year OS was 26% vs 16%</div>
What was the downside of the EORTC 08993/22993?
This trial was performed prior to the MRI area.
What was the downside of the FIRE-SCLC trial?
It was a retrospective study with propensity score analysis which does not replace a randomized trial.
What was the regimen studied in the RTOG 9410?
Concurrent vs sequential CRT being;<div>seq cis/vinbl then 60 Gy</div><div>vs</div><div>con cis/vinbl + 60 Gy RT</div><div>vs</div><div>conc cis/etoposide RT BID</div>
In the INT 0139 / RTOG 9309, what was median OS and 5-yrs OS for neoadj CRT + surgery vs definitive CRT?
Median OS was 23 months in both arms<div>5-yrs OS was 27% vs 20%, but NS</div>
What was the conclusion of the SWOG 9416 / INT 0160 trial?
For superior sulcus tumors, chemoRT followed by surgery then adjuvant chemo is feasible and with favorable response, LC and OS.
What was median PFS, median OS and median time to DM or death in the PACIFIC trial comparing adjuvant durvalumab in stage III NSCLC treated with CCRT to placebo?
Median PFS: 17.2 vs 5.6 months<div>Median OS: 47.5 vs 29 months</div><div>Median time to death or DM: 28.3 vs 16.2 months</div>
What was the conclusion of the EORTC 08993/22993 study?
PCI reduces symptomatic brain mets and improves DFS and OS<div>1-yr OS: 27% vs 13%</div><div>1-yr symptom detected BM: 15% vs 40%</div>
What was the rate of 3D-CRT in the LUNG-ART trial?
89%
What did the FIRE SCLC study investigate?
A retrospective study of 28 centers which compared SRS to WBRT in SCLC with brain metastasis.
In the RTOG 0617, what was the median OS in 74 Gy vs 60 Gy?
Median OS: 20 months for 74 Gy vs 29 months for 60 Gy
What were the radiation pneumonitis numbers in STRIPE vs WashU?<div><br></br></div><div><br></br></div>
<div>STRIPE:</div>
<div>V20<20%: 18% grade 2</div>
<div>V20 20-30%: 30% grade 2</div>
<div>V20 30-40%: 33% grade 2</div>
<div>V20 >40%: 36% grade 2</div>
<div><br></br></div>
<div>WashU</div>
<div>V20<22%: 0%</div>
<div>V20 22-31%: 8%</div>
<div>V20 32-40%:13%</div>
<div>V20>40%: >35%</div>
What was the study set-up of the EORTC 08941?
Induction platinum-based chemo X3, then if response radical resection +/- PORT<div>vs</div><div>60 Gy definitive RT</div>
<div>Which study group did the 'local consolidative treatment' of OliGomez MDACC study?</div>
Stage IV NSCLC, 0-3 oligometastases as counted after chemo.
What is the cited absolute OS benefit in limited stage SCLC for CCRT vs chemo only.
Absolute 5% benefit in OS according to a meta-analysis of the Toronto group<div>Similar results in a meta-analysis of Gustave-Roussy</div>
What did the NRG/RTOG 0937 study?
Patients with ES-SCLC, consolidative RT to thorax and original sites of mets
What were the results (MS) of the EORTC 08941?
No difference in MS, 16.4 months vs 17.5 months between surgery vs definitive RT arm
What was the conclusion of the EORTC 08941?
After response to induction chemo then surgery, surgery doesn’t improve OS of PFS compared to chemoRT alone in stage IIIA N2 NSCLC
“What was the most important result of the RTOG 0813 study ‘dose escalation in centrally located tumors””?”
3/25 deaths in the 11.5 Gy and 1/21 deaths in the 12 Gy<div>3 of these deaths were bronchopulmonary hemorrhages.</div><div>–> lower doses seem preferred</div>
Describe study methods of the CALGB 30610 dose-escalation trial for limited stage SCLC?
45 Gy BID<div>vs</div><div>70 Gy</div><div>vs</div><div>61.2 Gy in 1.8 concom boost, qday for 16 fx then BID for 9fx</div><div><br></br></div><div>with cis/etoposide 4 cycles, then PCI if CR or near CR</div>
What was 2-yr LF and 2 and 5-yr OS in ENI vs IFRT in the Shandong Cancer Hospital & Institute?
2 yr LF: 51% in ENI and 36% in IFRT<div>2-yr OS 26% ENI vs 39% IFRT (p = 0.048)</div><div>5-yr OS 18% vs 25% (NS)</div>
What did the INT PCI 99-01/EORTC/RTOG 0212/IFCT study?
Dose escalation for PCI in patients with limited-stage SCLC in CR after chemo and RT<div>25 Gy /10fx</div><div>vs</div><div>36 Gy/18 QD or 36 Gy/24 BID</div>
What was the maximum tolerated dose in the MSKCC dose-escalation trial?
84 Gy
What were the findings of the CALGB 8433?
Induction chemotherapy improves OS in NSCLC<div>Median OS 9.7 months vs 13.8 months in induction group</div>
What was the conclusion of the study investigating adjuvant docetaxel after definitive chemoRT?
Consolidation docetaxel after RT with concurrent cisplatin and etoposide results in increased toxicity with no improvement in OS.
What was the conclusion of the LUNG-ART study?
There was no benefit in DFS or OS with post-op RT for N2 disease with complete resection<div>RT had less mediastinal recurrence and death from progression, but higher deaths from toxicity</div>
What was the result of the FIRE-SCLC study?
WBRT was associated with improved CNS-TTP over SRS but not OS
What are lung constraints in the IMPRINT ph III trial (IMRT in malignant mesothelioma)
lung V20 < 37%, mean < 20.5 Gy<div>ipsilateral each lung V40 <67%</div><div>contralateral Lung R V5%<50% - lung L mean <8</div>
In the PET-Plan study, what was LRR in IFRT vs ENI?
14% in IFRT vs 29% in ENI (0.039)
Which study has replace the ANITA trial?
The LUNG-ART trial
What were the results of the Netherlands Cancer Institute study in terms of overall response rate, median PFS and median OS, in metastatic NSCLC comparing SBRT+pembrolizumab to pembrolizumab?
3-month overall response rate was 36% vs 18%, p=0.07<div>median PFS was 6.6 months vs 1.9 months (ns)</div><div>median OS was 15.9 vs 7.6 months (ns)</div><div><br></br></div><div>Overall response rate did not meet the predetermined thresholds but results do favor SBRT</div>
Kondo et al. (University of Tokushima, Japan) did a retrospective review of thymic epithelial tumors, what was OS in stage III/IV thymoma and thymic carcinoma STR vs GTR?
stage III-IV: 5-yrs OS was 93% for GTR - 64% for STR<div>Thymic carcinoma: 5-yrs OS was 67% for GTR, 30% for STR</div>
What was the study population studied in the RTOG 0617?
Unresectable stage III NSCLC<div>N = 544</div>
What was median OS and 5-yr OS in the SABR COMET study?
Median OS 50 vs 28 months<div>5-year OS 42% vs 18% (significant)</div>
What is the study design of the SAKK17/04 trial in mesothelioma patients (stage T1-3, N0-2, M0)
Phase III ranzomized<div>3 cycles of cis/pemetrexed –> EPP –> if macroscopic resection –></div><div>RT vs no RT</div>
Which studies established IFRT vs elective nodal irradiation in NSCLC?
PET-PLAN and a study of Shandong Cancer Hospital & Institute
How was the phase III clinical trial called which investigated PCI-HA (PCI-hippocampal avoidance)?
The ‘PREMER’ trial.
How can you interpret the results of the IMpower133 trial?
First line atezolizumab in extensive stage SCLC improves OS and PFS, and delays time to intracranial progression
What was the patient population studied in the INT 0139 / RTOG 9309?
Patients with stage IIIA (pN2) NSCLC, technically resectable<div>N = 396</div>
What was the rate of acute esophageal toxicity (grade 3-4) in concurrent vs sequential chemorads?
18% vs 4%
What were the results of ‘ANITA’s’ subanalysis regarding PORT.
pN1: Benefit for PORT if no chemo given<div>2.2 yrs vs 4.2 yrs<br></br><div>pN2: Benefit for PORT with and without chemo</div></div><div>with chemo: 2.0 yrs vs 3.9 yrs</div><div>without chemo: 1.1 yrs vs 1.9 yrs</div>
Describe the dose-escalation RTOG 0813 trial for centrally located tumors?
SBRT trial in centrally located T1-T2<5cm tumors, medically inoperable<div>Dose escalation 10, 10.5, 11, 11.5, 12Gy SBRT x 5fx</div><div>Endpoint was grade 3+ toxicity</div>
What was the conclusion of the PCI dose escalation trial of INT PCI 99-01/EORTC/RTOG 0212/IFCT study.
OS was worse in higher dose
What was the 2-year OS of the CREST trial evaluating thoracic RT + PCI vs PCI in patients with ES-SCLC with response to chemo?
2-yr OS was 13% vs 3% (significant!)<div><br></br></div><div>–> Consolidative thoracic RT improves OS in extensive stage SCLC that responded to chemo</div><div>Benefit only in those with residual disease (which 89% of patients had)</div>
What is the ongoing NRG CC009 trial?
<div>It is a trial in SCLC with 1-10 brain mets comparing SRS vs 30 Gy hippocampal avoidance IMRT</div>
<div>Primary endpoint is time to cognitive failure</div>
What did the SPACE trial investigate and what was it’s study population?
SBRT vs EBRT in T1-2N0M0 inoperable patients or patients refusing surgery.
What was the conclusion of the RTOG 0236 trial?
SBRT for peripheral lung lesions is feasible and results in high LC and LRC.
What did the ADAURA trial investigate?
Osimertinib in NSCLC EGFR+ s/p complete resection and negative brain imaging.<div><br></br></div><div>Study set-up:</div><div>Osimertinib x3 years</div><div>vs</div><div>Placebo x3 years</div>
What were the results (median OS and PFS) of the SINDAS trial, evaluating SBRT for oligometastatic disease in NSCLC EGFR+
Median OS was 25.5 vs 17.4 months (p-value significant but 95% CI included 1…)<div>PFS: 20.2 vs 12.5 months</div>
What did the EORTC 08993/22993 in ES-SCLC study?
4-6 cycles of chemo, wait 4-6 weeks, then if any response to therapy –> PCI (20-30 Gy) vs observation
In the RTOG 0617, what was the 5-yr LF, LRF, PFS and DM for 74 Gy vs 60 Gy?
In the RTOG 0617, a dose escalation trial in unresectable stage III disease:<div>5-yr LF was 38% vs 46% (trend)</div><div>5-yr LRF was 35.7% vs 38.4% (p= 0.05)</div><div>5-yr PFS was 13% vs 18% (trend)</div><div>5-yr was 52% vs 58% (ns)</div>
How did the RTOG 0236 differ from the RTOG 0618?
<div>Both trials focused on SBRT for peripheral lesions</div>
<div><br></br></div>
In the RTOG 0236, <u>T1-T2</u> NSCLC, medically <u>inoperable</u>, peripheral lesions were investigated<div>In the RTOG 0618, <u>operable T1-3</u> N0M0 peripheral lesions were investigated</div>
What did the PACIFIC trial study?
Adjuvant durvalumab vs placebo in patients with stage III, unresectable NSCLC without disease progression after CCRT.
Other than the Japanese trial requiring MRI prior to PCI, what was another difference in the EORTC trial vs the Japanese trial which may have influenced study results?
The Japanese study screened for brain mets while the EORTC evaluated symptomatic brain mets only.
What was the study population studied in the RTOG 9410?
Locally advanced NSCLC<div>N = 597</div>
What was the conclusion of the SPACE trial?
SBRT has less toxicity than 3DCRT. SBRT has a trend towards less progression. There is no change in PFS or OS in SBRT vs 3DCRT
Whatwas median LR-RFS in the SAKK17/04 trial and what was the conclusion?
Median LR-RFS was 7.6 vs 9.4 months with RT<div>Findings did not support the use of hemithoracic RT after neoadjuvant CHT and EPP</div>
What did the RTOG 9410 study?
se cis/vinbl then 60 Gy<div>vs</div><div>conc cis/vinbl + 60 Gy RT</div><div>vs</div><div>conc cis/etop + RT BID</div>
How did the INT 0139/RTOG 9309 affect treatment of stage IIIA (N2) NSCLC
It provided the basis for surgical resection of stage IIIA (N2) with lobectomy
What was the difference in population between the INT 0139/RTOG 9309 vs EORTC 08941?
In the INT 0139/RTOG 9309, technically resectable stage IIIA (pN2) NSCLC was investigated.<div>In the EORTC 08941, technically unresectable (N2) NSCLC was investigated.</div>
Describe RT regimen for both arms in the SPACE trial.
SBRT 66 Gy/3fx to isocenter (~ 45 Gy/3 fx to PTV)<div>vs</div><div>70 Gy in 35 fx</div>
What was the conclusion of the Kondo retrospective review on thymoma’s regarding RT?
No benefit to RT in stage III-IV thymoma or thymic carcinoma, or in GTR stage II-III thymoma
What was for us the most important subanalysis of the ANITA trial?
The ANITA trial recommended 45-60 Gy for N+<div>They performed a subanalysis of the patients treated with RT</div>
What was RT regimen in the INT 0139 / RTOG 9309?
Neoadjuvant CRT + surgery: 45 Gy with concurrent cis/etop –> if no PD –> surgery<div>vs</div><div>Definitive RT: 61 Gy total</div><div><br></br></div><div>followed by adjuvant x2 cis/etop in both arms</div>
Which group demonstrated a clear benefit of starting RT early (i.e. with cycle 1 or 2) in limited stage SCLC?
UNC Chapel Hill, NC
What was the difference between the EORTC 08993/22993 PCI trial and the PCI trial performed by the National Kyushu Cancer Center (Fukuoka,Japan).
The Japanese trial required no brain metastases on MRI.<div>The EORTC trial was prior to the MRI era.</div>
What was the regimen used in the Shandong Cancer Hospital & Institute ENI study?
Induction chemo x1 followed by CRT and adjuvant CHT<div>ENI 60-64 Gy</div><div>vs</div><div>IFRT 68-74 Gy</div>
What was the study population of, and what did the INT 0139 / RTOG 9309 study?
The study population was stage IIIA (pN2) NSCLC, technically resectable<div>Goal of the study was to compare neoadjuvant CRT + surgery</div><div>vs</div><div>definitive RT</div>
What was 4-year OS in the patients treated adjuvant with durvalumab in the PACIFIC trial?
50% 4-year OS
What is the study design in the IMPRINT ph III trial in epithelioid or biphasic malignant pleural mesothelioma stage I-IIIA
pleurodectomy/decortication and pemetrexed+platinum<div>followed by</div><div>no RT vs hemithoracic pleural IMRT (45-50.4 Gy)</div>
What trial provides the basis for surgical resection of Stage IIIA (N2) with lobectomy?
INT 0139/RTOG 9309
Describe the study set-up of the PET-PLAN study.
RT to PET FDG avid sites and 50 Gy ENI<div>vs</div><div>RT to PET FDG avid sites only</div><div><br></br></div><div>60-74 Gy as high as feasible, concurrent chemo.</div><div>ENI was delivered to stations at >= 10% risk based on an algorithm</div>
What were the results of the Peking study cis/etop vs carbo/taxol in terms of 3-yrs OS?
3-yrs OS 41% vs 26% for cis/etop vs carbo/taxol
What did the lung cancer study group 821 investigate?
Lobectomy vs wedge resection with 2 cm margins in T1N0
What was 3-yr DFS and OS in the LUNG-ART study for radiation vs no radiation?
3-yrs DFS was 47% vs 44% (ns)<div>3-yr OS was 67 vs 69%</div>
What are the 2 main studies comparing SABR vs surgery? What were fractionation regimens in both of these studies?
STARS and ROSEL<div>STARS: Peripheral 54 Gy /3, central 50 Gy /4</div><div>ROSEL: 54 Gy/3 or 60 Gy in 5</div>
What was median OS in seq vs concurrent vs concurrent BID CRT in the RTOG 9410 trial?
14.6 months vs 17 months vs 15.6 months<div>(OS SS for arm 2 vs 1, but not for 2 vs 3)<br></br><div>–> Concurrent chemoRT with QD RT results in improved OS</div></div>
What was OS and LRF for concurrent vs sequential in the meta-analysis of Goustave-Roussy?
5-yr OS increased for concurrent: 15.1% vs 10.6%<div>5-yr LRF improved: 29% vs 35%</div><div><br></br></div><div>–> Concurrent chemorads improves OS compared to sequential CRT</div>
What was an important exploratory analysis that was performed in the INT 0139 / RTOG 9309 trial?
In exploratory analysis, patients with neoadj CRT followed by lobectomy has improved 5-yrs OS.<div>36% vs 18% 5-yrs OS (the 18% was a matched cohort receiving definitive CRT)</div>
What did the MISSILE study investigate?
<div>Pathological response after SBRT in T1-2 N0M0.</div>
What did the review of Curran (Fox Chase) conclude with regards to RT in stage II-III R0 thymoma patients?
In stage II-III, R0: mediastinal recurrence was 53% vs 0% with RT<div>–>R0 alone appears to be inadequate therapy in higher stage thymoma</div>
What did the RTOG 0236 study and what was the study population?
SBRT in peripheral tumors, NSCLC T1-T2, medically inoperable.
Describe methods of NRG/RTOG 0937.
Patients with ES-SCLC, 1-4 metastatic lesions and no brain metastases after CR/PR from 4-6 cycles platinum chemo<div><br></br></div><div>PCI 25 Gy only</div><div>vs</div><div>PCI and consolidative RT to thorax and original sites of mets</div><div><br></br></div><div>Recommended dose to chest and mets was 45 Gy in 15 fx but 30-40 Gy was also allowed</div>
What were the results of the NRG/RTOG 0937 trial investigating consolidative RT to thorax and mets in ES-SCLC?
Consolidative RT to thorax and extracranial metastases delayed progression but did not improve 1-year OS.<div>The trial was closed early due to futility.</div>
What was median OS and PFS in the IMpower133 trial (carbo/etop +/- atezolizumab.
Median OS was 12.3 months vs 10.3 months<div>Median PFS was5.2 months vs 4.3 months</div><div>in</div><div>atezolizumab + carbo/etop vs placebo + carbo etop</div>
What were the conclusions regarding RT in the Japanese retrospective review in Masaoka stage II-III thymoma and thymic carcinoma patients?
Stage II-III thymic carcinoma, RT was associated with improves RFS but not OS<div>Stage II-III thymoma, RT was not associated with benefit in RFS or OS</div>
